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Perio--Surgical (Spring) > 7. Root Amputation and Hemisection > Flashcards

7. Root Amputation and Hemisection Flashcards

1
Q

Under what circumstance is it safe to determine that there has been an increase in bone loss when looking at X-rays from two different time periods

A

if the angulation at which the two X-rays taken is the same

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2
Q

What kind of flap is needed for root resection or hemisection

A

full thickness mucoperiosteal flap

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3
Q

Describe the Lindhe classification system for horizontal furcation classification

A
  • Grade I= Loss of interradicular bone less than or equal to 1/3
  • Grade II= Loss of interradicular bone greater than 1/3 but not through and through
  • Grade III= Complete loss of interradicular bone (through and through)
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4
Q

Describe the furcation classification system we use for furctions

A
  • 1= Can feel the diversion of the roots
  • 2= Can insert the probe 1-2 mm into furcation (not through and through)
  • 3= Through and through
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5
Q

Which Dx takes presidence a radiographic class III furcation or a clinical class II furcation

A

Radiographic

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6
Q

Why is it that the clinical can be less than the radiographic classification

A

Because if the soft tissue CT is tightly adherent to the tooth it prevents the migration of the probe

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7
Q

What are the probes used for Dx of furcations

A

Nabors or pig tail probe

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8
Q

Calibrations on Nabors or pig tail probe are useful for

A
  • Dx of furcations

- Observing the effectiveness of treatment after a certain amount of time post op

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9
Q

Factors to consider in treating furcations

A
  • Degree of involvement (Dx –>prognosis)
  • Tooth anatomy (and root anatomy)
  • Strategic value of tooth
  • Tooth mobility
  • Endo therapy (is it possible)
  • Periodontal condition of adjacent teeth
  • Prosthetic requirements
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10
Q

The root trunk width is defined as the distance between

A

the CEJ and the roof of the furcation

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11
Q

More ideal to have a (wide/narrow) root trunk and why

A

Wide because there is more CT attachment and more resistant to furcation involvement in presence of inflammation

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12
Q

Considerations for tooth anatomy for treating furcations

A
  • Width of root trunk
  • Cervical enamel projections
  • Root separation/ fused roots
  • Root proximity
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13
Q

-% of molar teeth have cervical enamel projections

A

5-10%

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14
Q

(Separated/fused) roots presents a more difficult clinical scenario for treating furcations

A

fused

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15
Q

What roots in the mouth are most often in close proximity to one another

A

DB root of the maxillary 1st molar and the MB root of the maxillary 2nd molar

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16
Q

There is no (bone/CT) on enamel

A

both

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17
Q

Which has the best prognosis and why

  • Widely separated roots
  • Roots separated but close
  • Fused roots separated in apical portion
  • Presence of enamel projection
A

Widely separated roots because it is easier to access and more likely to get bone fill

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18
Q

Teeth with cervical enamel projections have (wide/narrow) root trunk widths

A

narrow

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19
Q

Challenge with SRP in furcations and how can slighly improve this challenge

A

-Narrow furcations difficult to instrument…. can take a round bur and perform and odontoplasty to open the furcation making it less narrow

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20
Q

Teeth with CEP have (more/less) complicated anatomy

A

more

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21
Q

Management of CEP

A

odontoplasty to expose cementum/dentin for CT attachment

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22
Q

Acronym for treatment of furcations

A

MARC

  • Maintenance the furcation
  • Access the furcation
  • Remove the furcation
  • Close the furcation
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23
Q

Treatment options for Class I furcation

A
  • Maintain the furcation (“M”)
  • SRP **most common tx)
  • Sometimes treated with GTR
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24
Q

T/F Treatment options for Class II and III furcations are the same

A

t

25
Q

Treatment options for Class II and III furctions with MARC

A 
M= SRP
A= apically positioned flap, odontoplasty, osteoplasty and ostectomy 
R= root resection or hemisection 
C= Flap curretage with GTR and barrier membrane (also for class III-- exo)
26
Q

GTR is more effective in treating class (II/III) furcations

A

II

27
Q

What type of flap is done for GTR

A

coronally positioned flap

28
Q

What kind of flap is done for ostectomy/osteoplasty/ odontoplaty

A

apically positioned

29
Q

SRP is not a good treatment option for Class (I/II/III) furcation

A

II and III UNLESS there is a lot of recession- but typically a flap needs to be reflected

30
Q

Hemisection is most commonly done with what teeth

A

mandibular molars (aka bicuspidization)

31
Q

Root amp is most commonly done to what root

A

DB root of the maxillary 1st molar

32
Q

T/F No solid evidence for the effectiveness of GTR in class III furcations

A

t

33
Q

What is tunneling and is this a technique commonly done with class (I/II/III) furcations

A

dropping the gingival margin below the furcation to allow the patient to clean the furcation with a proxy brush… done with class III furcations

34
Q

Optimal root form for the treatment of furcations includes what properties

A
  • Good root length (C:R ratio)
  • Divergent roots (plenty CT and bone between roots)
  • Wide root trunk
  • Excellent C:R ratio
35
Q

Root form contraindicating root resection

A
  • Root trunk too long and roots too short

- Roots fused

36
Q

Indications for root resection

A
  • Deep Class II furcation
  • Class III furcation
  • Advanced caries (root caries)
  • Gingival recession on a single root
  • Root proximity
  • Endo failure/ inability to perform endo treatment
  • Tooth (or root) fracture
  • Root resoprtion/ perforation
  • Severe vertical bone loos on single root
37
Q

Why is root proximety an issue

A

-Leaves small sliver of bone between the teeth that quickly resorbs if inflammation is present

38
Q

What is the issue with doing a root resection on a mandibular molar tooth

A

-One root to support a large crown can lead to tipping of tooth unless prsothodontically held in place

39
Q

Hemisection of a mandibular molar is also called

A

bicuspidization

40
Q

How do you know which root to remove in a root amp

A
  • Best eliminates furcation
  • Has least amount of bone and attachment
  • Best contributes to elimination of perio issues on adjacent teeth
  • Has most anatomical issues (i.e curved roots, developmental grooves, root flutings, accessory/multiple canals)
  • Least complicates future perio maintenance
41
Q

What kind of flap is done for hemisection

A

apically positioned

42
Q

Endo should be done (before/after) hemisection and/or root amp

A

before

43
Q

Contraindications for root resection

A
  • Insufficient bone on remaining roots
  • Poor OH
  • Moderate to high caries activity
  • Unfavorable root anatomy
  • Discrepancies in adjacent proximal bone height
  • Other more predictable or cost effective therapy (i.e implant)
  • Non-restorability of remaining roots
  • Inability to endo treat roots
44
Q

Success rate for root resected teeth

A

95.2-100%

45
Q

Lowest success rate was for what tooth and what was it

A

distal root of mandibular molar (75%)

46
Q

Overall the success rate of root amp is (good/poor)

A

good

47
Q

Procedure for root amp

A
  • Full thickness flap
  • Section and remove root
  • Suture
  • Odontoplasty
48
Q

Why are DB roots of maxillary 1st molars the most commonly amputated root

A

they rotate in the socket and commonly form fenestrations or dehiscences

49
Q

Directional movement of the bur when resecting a root

A

Start toward the furcaitonal aspect of the tooth and move out with a round bur

50
Q

Purpose of odontoplasty for root amp

A

Obtain optimal contours of the tooth so the patient can keep the area clean otherwise perio issue will worsen

51
Q

Describe the endo to be done for a maxilalry 1st molar that requires resection of the DB root

A
  • Obturate all canals except DB

- Amalgam plug in DB root canal

52
Q

Cut for the hemisection starts where

A

the furcation

53
Q

Compare the success of root resections/hemisections and implants

A

No complications….

  • Hemisected teeth= 68%
  • Implants= 89%

**hemisected mandibular molars were more prone to complications than implants

54
Q

Describe the efficacy of perio regeneration for Class I furcations

A
  • Most defects treated successfully with non-regenerative therapy
  • GTR may be beneficial in certain areas
55
Q

Describe the efficacy of perio regeneration for Class II furcations

A
  • Regenerative therapy= predictable

- Regeneration seen clinically and histologically

56
Q

Describe the efficacy of perio regeneration for Class III Mandibular molar furcations

A

-One case reports regeneration histologically

57
Q

Describe the efficacy of perio regeneration for Class III Maxillary molar furcations

A
  • GTR is not predictable

- Shown only in clinical case reports

58
Q

Describe the efficacy of perio regeneration for Class II and III furcations in Maxillary 1st PM furcations

A
  • GTR not predictable

- Single trial of Class I and II defects

Perio--Surgical (Spring) (8 decks)

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