Furcation Flashcards
Furcation
is the anatomic part of the multirooted tooth where the root divided from the common root trunk
Furcation Involvement
refers to a condition in which the bifurcations and trifurcations of multi-rooted teeth are invaded by periodontal disease process Characterized by bone resorption and attachment loss in the interradicular space
Root complex
is the portion of a tooth that is located
apical of the cemento-enamel junction (CEJ)
Root complex IS DIVIDED into
The root complex may be divided into two parts:
the root trunk and the root cone(s)
The root trunk represents the undivided region of the Root
The root cone is included in the divide region of the root complex
Furcation Entrance
the transitional area between the undivided and the divided part of the root
Fornix
The roof of the furcation
Glickman (1953): Based on —– component of furcation area
Horizontal
Tarnow and Fletcher (1984): Based on —— component of furcation area.
Measured the distance between fornix to the alveolar bone of the adjacent two roots
vertical
Tarnow And Fletcher Classification
Grade A: 1-3 mm
Grade B: 4-6 mm
Grade C: > 6 mm
Root trunk
Represents the undivided region of the root. The height of the root trunk is the distance between the CEJ and the separation line between two root cones
% Of root concavities on mandibular and maxillary tooth roots
Mandibular Molars
100% mesial roots
99% distal roots
Maxillary Molars
94% mesiobuccal roots
31% distobuccal roots
17% palatal roots
% of molars have CEPs
13
The following parameters should be recorded to evaluate the amount of tissue loss in periodontal disease and also to identify the apical extension of the inflammatory lesion
pocket depth (probing depth)
attachment level (probing attachment level)
furcation involvement (measured with nabers probe)
Radiograph
What are the treatments for Furcation I?
Answer: Scaling and root planning, Furcation plasty
What are the treatments for Furcation II?
Answer: Furcation plasty, Tunnel preparation, RSR, GTR
What are the treatments for Furcation III?
Answer: Tunnel preparation, RSR, Tooth extraction
Most effective in grade I and shallow grade II.
SRP
Furcation plasty?
Tooth substance is removed (odontoplasty) and the alveolar bone crest is remodeled (osteoplasty) at the level of the furcation entrance
Furcation plasty procedure?
Reflection of soft tissue flap.
Removal of the inflammatory soft tissue
scaling and root planning of the exposed root surfaces.
The removal of crown and root substance in the furcation area (odontoplasty)
The recontouring of the alveolar bone crest (osteoplasty)
positioning and the suturing of the mucosal flaps at the level of the alveolar crest in order to cover the furcation entrance with soft tissue.
Root Seperation
involves the sectioning of the root complex and the maintenance of all roots
Root resection
involves the sectioning and the removal of one or two roots of a multirooted tooth
RSR is indicated in ?
deep degree II and degree III furcation involved molars.
Criteria for RSR?
The length of the root trunk:
A tooth with a short root trunk is a good candidate for RSR;
The divergence between the root cones:
Roots with a short divergence are technically more difficult to separate than roots which are wide apart
The length and the shape of the root cones:
Short and small root cones following separation tend to exhibit an increased mobility
Amount of remaining support around individual roots:
This should be determined by probing the entire circumference of the separated roots
Stability of individual roots:
Access for oral hygiene devices:
RSR procedure?
Endodontic treatment
Provisional restoration
RSR
Periodontal surgery
Final prosthetic restoration
Hemisection requirements for mandibular molars?
Mandibular molars
Grade III furcation
Need widely separated roots
Soft tissue positioned below level of pulp chamber
Indications and contraindications for root resection?
indications: gr 2,3
contraindications:
Inadequate bone support
Fused roots
Inoperable endodontically
Patient considerations
GTR is more successful in degree —– furcation involvements then in degree —— involvements
2,3
GTR limitations?
The morphology of the periodontal defect -> Horizantal bone loss
The anatomy of the Furcation with complex morphology -> more in maxillary than mandibular tooth
The varying and changing location of the soft tissue margins during the early phase of healing with a possible recession of the flap margin and early exposure of both the membrane material and the fornix of the Furcation
