Furcation Involvement

Question 1

What is furcation involvement

Answer 1

Pathologic bone loss in anatomic area of multi rooted teeth

Question 2

1. What is the primary etiologic factor we suspect when we see furcation invasion?
2. Besides plaque-induced inflammation, what other things should we look for when we see a furcation invasion?

Answer 2

1. Bacterial plaque and the immunoinflammatory response which results in attachment/bone loss
2. Anatomic Factors
   Pulpal Necrosis
   Iatrogenic
   Root Fracture

Question 3

What is the size of the furcation entrance?

Answer 3

81% below 1 mm

58% below 0.75 mm

Question 4

What % of patients have furcation below 0.75mm?

Answer 4

58%

Question 5

What is Glickmans furcation classification

What is it designed for– horizontal or vertical classification?

Answer 5

Grade 1: Into fluting
Grade 2: Cul de sac
Grade 3: Through and through
Grade 4: Through and through and see through (visible clinically)

Glickman = Horiztonal

Question 6

What is Hamps classification of furcations?

Answer 6

Degree 1: Horizontal loss <3 mm

Degree 2: Horizontal loss >3mm but not through and through

Degree 3: through and through furcation involvement

Question 7

What is Tarnow classification of furcations?

Answer 7

- from dome to base of probing
Subclass A: 1-3 mm from root of furcation
Subclass B: 4-6 mm from roof of furcation
Subclass C:  7mm+ from roof of furcation

Question 8

What is the relevance of Tarnow’s classification?

Answer 8

Ameniability to grafting

It includes the vertical component of furcation classification

Question 9

What are the goals of furcation treatment?

Answer 9

1. Produce local environment you can maintain to prevent further attachment loss
2. Retention of the tooth
3. Regeneration of lost periodontal attachment

Question 10

How do you manage a moderate furcation defect?

Answer 10

a. Treatment varies with height and volume of attachment loss, Configuration of defect, Tooth anatomy
b. Most important is to obliterate the furcation

Question 11

What is osteoplasty?

Answer 11

Reshaping the interradicular bone of furcation involvement?

Question 12

What is odontoplasty

Answer 12

Reducing the intermediate bifurcation ridge and
the extent of dome over the furcation (the tooth surfaces)

–> reducing the volume of the furcation defect

Question 13

Why do we resect a root?

Answer 13

Obliterate furcation while leaving the crown in function

Question 14

What are the Indications of root resection?

Answer 14

1. Severe vertical BL
2. Furcation Invasion NOT correctable with odontoplasty
3. Not maintainable
4. Hopeless root
5. Fractured tooth
6. Root dehisence
7. Cannot do endo on one root
8. Root resorption on root

Question 15

Contra indications of root resection?

Answer 15

1. Advanced bone loss
2. Fused roots
3. Cannot do endo treatment
4. Tooth is not a good abutment
5. Poor perio support
6. Poor OH
7. Expensive

Question 16

How do you decide which root to resect?

Answer 16

1. The one that has the furcation invasion around it
2. With the most attachment loss and least remaining attachment
3. One hardest for endodontist to treat

Question 17

What is the number 1 cause of failure of root resections?

Answer 17

Leaving a “lip” of tooth structure – this becomes a major plaque trap

Question 18

What are the Restorative considerations for root resection / hemi section?

Answer 18

a. Remaining root length

b. Internal anatomy

Question 19

What is the prognosis of root resection / hemi section?

Answer 19

90% long term survival rate

Question 20

What is the purpose of a tunneling procedure?

Answer 20

To intentionally turn a Grade II or III furcation into a Grade IV furcation so that the patient and dentist can keep it clean

Question 21

Tunneling procedures have a high incidence of what?

Answer 21

Root Caries

Question 22

What furcation grade responds best to treatment?

Answer 22

Grade II