7. Root Amputation and Hemisection Flashcards by Janae Garofalo

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

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

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What kind of flap is needed for root resection or hemisection

full thickness mucoperiosteal flap

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Describe the Lindhe classification system for horizontal furcation classification

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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Describe the furcation classification system we use for furctions

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

Radiographic

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

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

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What are the probes used for Dx of furcations

Nabors or pig tail probe

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Calibrations on Nabors or pig tail probe are useful for

Dx of furcations

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

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Factors to consider in treating furcations

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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The root trunk width is defined as the distance between

the CEJ and the roof of the furcation

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

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

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Considerations for tooth anatomy for treating furcations

Width of root trunk
Cervical enamel projections
Root separation/ fused roots
Root proximity

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-% of molar teeth have cervical enamel projections

5-10%

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

fused

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

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

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There is no (bone/CT) on enamel

both

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Which has the best prognosis and why

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

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

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

narrow

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

-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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Teeth with CEP have (more/less) complicated anatomy

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Management of CEP

odontoplasty to expose cementum/dentin for CT attachment

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Acronym for treatment of furcations

MARC

Maintenance the furcation
Access the furcation
Remove the furcation
Close the furcation

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Treatment options for Class I furcation

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

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

Treatment options for Class II and III furctions with MARC

``` 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) ```

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

What type of flap is done for GTR

coronally positioned flap

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

apically positioned

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

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

Hemisection is most commonly done with what teeth

mandibular molars (aka bicuspidization)

Root amp is most commonly done to what root

DB root of the maxillary 1st molar

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

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

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

Optimal root form for the treatment of furcations includes what properties

- Good root length (C:R ratio) - Divergent roots (plenty CT and bone between roots) - Wide root trunk - Excellent C:R ratio

Root form contraindicating root resection

- Root trunk too long and roots too short | - Roots fused

Indications for root resection

- 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

Why is root proximety an issue

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

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

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

Hemisection of a mandibular molar is also called

bicuspidization

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

- 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

What kind of flap is done for hemisection

apically positioned

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

before

Contraindications for root resection

- 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

Success rate for root resected teeth

95.2-100%

Lowest success rate was for what tooth and what was it

distal root of mandibular molar (75%)

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

good

Procedure for root amp

- Full thickness flap - Section and remove root - Suture - Odontoplasty

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

they rotate in the socket and commonly form fenestrations or dehiscences

Directional movement of the bur when resecting a root

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

Purpose of odontoplasty for root amp

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

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

- Obturate all canals except DB | - Amalgam plug in DB root canal

Cut for the hemisection starts where

the furcation

Compare the success of root resections/hemisections and implants

No complications.... - Hemisected teeth= 68% - Implants= 89% **hemisected mandibular molars were more prone to complications than implants

Describe the efficacy of perio regeneration for Class I furcations

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

Describe the efficacy of perio regeneration for Class II furcations

- Regenerative therapy= predictable | - Regeneration seen clinically and histologically

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

-One case reports regeneration histologically

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

- GTR is not predictable | - Shown only in clinical case reports

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

- GTR not predictable | - Single trial of Class I and II defects