exam 2 (L10) - furcation management Flashcards
what anatomical structures must be considered when managing furcations?
- root trunk
- furcation entrance
- root surface anatomy
- enamel projections
- accessory canals
what compromises the root trunk, and how does the root trunk affect periodontal tx?
- root trunk = undivided portion of root
- long root trunks make CCL easier
- problematic if pt has periodontitis b/c more area to treat
what are the fornix and furcation entrance?
- fornix = roof of furcation
- furcation entrance = transitional area between undivided and divided portion of root
- need slim ultrasonic devices to clean
how does the furation entrance diameter relate to the blade width of a new curette?
- blade width of new Gracey curette = 0.75 mm, and 60% of molar furcation entrances are smaller than that (so use slim ultrasonic)
- in mandibular molars, FE wider B than L
- in maxillary molars, FE wider M > D > B
what is the prevalence of root concavities in mandibular and maxillary teeth, and what is their significance to tx?
- mandibular: 100% mesial roots, 99% distal roots
- maxillary: 94% MB roots, 31% DB roots, 17% palatal roots
- root concavities complicate cleaning
what is the significance of cervical enamel projections (CEP), and what is a term for a very large CEP?
- PDL/CT can’t attach to enamel, so CEP areas apical to CEJ have intrinsic AL, leading to pathogen susceptibility
- large CEP = enamel pearl (most often max 2nd molar)
- if you see a CEP/enamel pearl, do odontoplasty!
what are the 4 classifications of furcations using the Glickman system?
- class I = catch with probe, no radiolucency
- class II = varies from catch to deep penetration
- class III = through and through
- class IV = clinically visible
differential diagnosis: what 3 factors discussed can cause furcation radiolucency?
- periodontitis/inflammation
- trauma from occlusion (TFO) (BL, but not AL)
- pulp pathology or poorly treated RCT
- end tx (RCT) > perio tx
which mentioned antimicrobials are used in combination with SRP, and what is their effectiveness on furcation areas?
- chlorhexidine
- tretracycline fibers
- antimicrobials NOT effective for furcation areas
what is the most effective method of furcation management via cleaning?
- open debridement
+ much more effective than closed debridement - use ultrasonic cleaners for narrow furcations
which treatment option is most effective for grade II furcations? technique?
- osseous surgery (OS)
- technique:
+reduce horizontal depth of lip partially blocking furcation
+ make bone ramps into the furcation to help plaque control
+ reduce probing depths
in MAXILLARY molars, what technique might be done to help manage furcation problems when cleaning is ineffective?
- root resection
when is root resection indicated and contraindicated?
- indicated: class II and III furcations with poor cleaning
- contraindicated:
+ inadequate bone support
+ fused roots
+ inoperable endodontically (need RCT for root resection)
what is the treatment sequence for root resectioning (RSR)?
- endo RCT
- provisional restoration
- RSR
- perio surgery
- final prosthetic restoration (crown?)
what factors must be considered for root resection (RSR)?
- length of root trunk
- divergence between root cones
- length and shape of root cones
- fusion between root cones
- amount of remaining support around individual roots
- stability of individual roots
- access for oral hygiene devices
in MANDIBULAR molars, what technique might be done to help manage furcation problems when cleaning is ineffective?
- hemisection
- used for class III furcations
- need widely separated roots
- soft tissue must be positioned below level of pulp chamber
- “create 2 premolars from a molar”
what is a root separation technique?
historical technique that sections root complex to maintain all roots (similar to maxillary root sectioning and mandibular hemisection)
what is “tunneling,” and when is it performed?
- creating a class III furcation from a class II furcation
- done to aid patient in removing plaque in furcations
- moderate failure rate, recurrent periodontitis, and root caries are common, esp if patient is on antihypertensives or other medications that cause xerostomia
when and how are furcation defects regenerated?
- when class II furcations are present
- use GTR to regenerate
- most predictable in mandibular molars
- sometimes used in class III furcations, but it is unpredictable
regarding furcation defects, when might extraction be a suitable form of tx?
- AL so extensive roots can’t be maintained
- tooth/gingival anatomy complicates plaque control
- endo or restorative reasons
- implant placement (osseointegrated)
how good is the longevity of properly treated teeth with class III or less furcation involvement?
very good; 70% pt. retained teeth after 22 years in one study
what local, behavioral, and systemic factors affect treatment of patients with furcation problems?
- oral hygiene
- compliance
- stress
- intraoral accessability
- uncontrolled diabetes
- smoking
- healing response to previous therapy
